Objectives

Emergency department (ED) crowding is a growing problem across

the world. Hospitals need to identify the situation using emergency

department crowding scoring systems and to produce appropriate

solutions.

Methods

A new program (Electronic Blockage System, EBS) was written supplementary

to the Hospital Information System. It was planned that the

number of empty beds in the hospital should primarily be used for patients

awaiting admission to a hospital bed at the ED. In the presence of

patients awaiting admission at the ED, non-urgent admissions to other

departments were blocked. ED overcrowded was measured in the

period before initiation of EBS, the early post-EBS period and the late

post-EBS period, of one-weeks duration each, using NEDOCS scoring.

Results

NEDOCS values were significantly lower in the early post-EBS period

compared to the other periods (p<0.0001). Although outpatient

numbers applying to the ED and existing patient numbers at time of

measurement remained unchanged in all three periods, the number

of patients awaiting admission in the early post-EBS period was significantly

lower than in the pre-EBS and late post-EBS periods (p=0.0001,

p=0.001).

Conclusions

EBS is a form of triage system aimed at preventing crowding and ensuring

the priority admission of emergency patients over that of polyclinic

patients. In hospitals with an insufficient number of total beds it can

be used to reduce ED crowding and accelerate admissions to hospital

from the ED.

Key words: Emergency department; National Emergency Department

Overcrowding Study; NEDOCS; overcrowding.

Universitas Indonesia Library

The Crystal of Knowledge

Malcolm Baldrige adalah salah satu metode yang digunakan untuk menilai
performa perusahaandan meningkatkan kinerja perusahaan yang ekselen. Malcolm
Baldrige membantu menghasilkan kinerja ekselen dari design yang dibuat. Banyak
perusahaan yang ingin mengetahui perkiraan score sementara
menggunakancertified assessment. Certified assessment membutuhkan
kompleksitas dan biaya yang tinggi, sehingga perusahaan membutuhkan internal
assessment dengan menggunakan media berupa sistem perangkat lunak.Sistem
perangkat lunak dapat mempermudah perusahaan dalam melakukan pengukuran
dan penilaian performa perusahaan.Penelitian ini menghasilkan sistem perangkat
lunak yang khusus untuk Malcolm Baldrige kriteria pertama (kepemimpinan).Sistem
perangkat lunak ini dapat menghasilkan score setiap pendekatan analisa Approach,
Deployment, Learning dan Integration (ADLI) dan juga score total masing-masing
item kriteria pada kriteria pertama (kepemimpinan) yaitu item kriteria 1.1 dan 1.2.

Abstract
This study has a background unsatisfactory surveys that have been done by PKMPRS
(Committee on Hospital Quality Control Service) of Sumber Waras Hospital, that did not take
notice of research requirements. The conclusion as the results of the surveys that have been held
by PKMPRS were general. The results were difficult in interpretations and interventions.

This survey attempts to measure patient satisfaction and the level of satisfaction for Emergency
Departments of Sumber Waras Hospital, analyze several factors that could influence satisfaction
in the efforts to improve service quality..

This research is a survey that use qualitative approach. Data collected through questionnairre
during July 2003.

400 questionnairres have been taken for this survey after passing the judging group assessments.
The questionnairres have been tried out for validity and reliability at 2 emergency departments of
Persahabatan and Sumber Waras Hospital. The results of validity and reliability have been
known that the instrument has strong validity and reliability. Analysis have been done for
univariate, bivariate and multivariate.

Several factors influencing patient satisfaction observed with personal characteristics and 5
service quality, i.e.: tangible, reliability, responsiveness, assurance and empathy.
Univariate analysis have been done for personal characteristic of the respondents and items in 5
service quality demention. Bivariate analysis used to find correlation beetwen personal
characteristic of the respondents and items in 5 service quality.

Importance and performance analysis have showed that 88% of the respondents have been
satisfied in approving Emergency Department of Sumber Wares Hospital services.

To gain the priority way out that could improve service quality have been used Cartesius
diagram.
There were this thesis purposes the way customer satisfaction and efforts that could make an
improvement of Emergency Department of Sumber Waras Hospital .
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RSUD Pasar Rebo held status as swadana hospital since the end of year 1992 and at
the beginning of year 2005 will be BUMD. KepPres No 40 year 2001 talking about
BUMD Hospital, and therefore the management of hospital will direct the
operational of hospital into autonom management. This July 2004, RSUD Pasar Rebo
is preparing to get ISO 9001, 2000 certificate. Therefore the management keep
trying to increase the quality of care and performance_ To have good quality of
health care, it's needed a better management system dan have clear performance
indicator. Performance indicator of nursing is one of important performance
indicator to measure the success of the hospital. This performance indicator of
nursing is needed to measure performance, RSUD Pasar Rebo doesn't have
performance of nursing measurement. The emergency unit is the front door of a
hospital and it needs good performance of nursing because the cases that are
handled are emergency cases that need quick response time so that the death can
be minimized. The emergency unit of RSUD Pasar Rebo have a higher visit than the
emergency unit from another hospital that is similar.

This study uses qualitative method to identify key performance indicator of nursing
for associate nurse and the head of nurse together with the emergency unit nurses.
To get primary information the researcher uses focus group discussion and interview
with the nurses in emergency unit. This study is only a preliminary study of
developing key performance indicator of nursing. It's needed another study to
develop good key performance indicator of nursing.

The result of this study is identification of 14 key performance indicators for

associate nurse which consist of 6 lag indicators and 8 lead indicators. And for the
head nurse we identify 25 key performance indicators consist of 14 lag indicators
and 11 lead indicators.
We hope that this key performance indicator of nursing can be developed into key
performance indicator for hospital. These indicators also can be developed to
measure performance. But it's needed a further study to develop key performance
indicator of nursing.

Performance Evaluation of Emergency Department at Atma Jaya Hospital in May 2002 Atma
Jaya hospital doesn't have the comprehensive performance evaluation. There are 75% patients of
in patient department come from emergency department, therefore emergency department need
to become Atma Jaya hospital priority for performance evaluation then it will become an input in
Atma Jaya hospital strategic planning. By using balanced scorecard approach, the performance
of emergency department can be evaluated through its commitment and the work satisfaction of
human resource in the emergency department, the process of patient service in the emergency
department, the satisfaction of the emergency departments patient, and the performance of the
financial of the emergency department.
This research was carried out by qualitative and quantitative descriptive, by using 23
respondents human resources of emergency department, 288 patients who came to be cared in
the emergency department during May 2002. The research was done by in depth interview,
questioner, and checklist. The collected data were analyzed by qualitative and quantitative
descriptive.
The result of the research shows that human resource indicator in emergency department is not
so good i.e. they are not satisfied and they do not commit to emergency department. The effect of
that not so good human resource indicator influences the patients service process to the patient
in emergency department. That not so good service process indicator influences the satisfaction
of the emergency department's patient. The unsatisfaction of emergency department's patients
especially about waiting time of care and the doctor's services. The unsatisfied patients to the
service in emergency department causes not so good effects to the emergency department's
earning to the hospital, so the hospital can not give subsidy as much as subsidy hoped by the
human resource of emergency department. Atma Jaya Hospital can uses this research to be
hospital foundation for next becoming performance evaluation, and Board of Director must
observe at a distance about Atma Jaya Hospital policy that uses to raise performance of
emergency department.